Corticosteroids up incidence of adverse events, readmissions in severe COPD

A single-institution study does not recommend the prescription of systemic corticosteroids for the treatment of severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as this might result in an increased incidence of adverse effects and readmissions.

In this single-centre, retrospective, observational study, the investigators assessed corticosteroid prescribing patterns for adults admitted for severe AECOPD from March to May 2019 at a large academic medical institution. Appropriate therapy was defined as treatment with prednisone 40 mg (or equivalent) for 5 days.

The frequency of appropriate dose and duration served as the primary outcome, while secondary ones included the prevalence of adverse events (new or worsening hyperglycaemia or hypertension) and 30- and 90-day readmission rates.

A total of 190 patients were included, of whom 16 (8.4 percent) had an appropriate duration and eight (4.2) an appropriate dose. In addition, only four patients (2.1 percent) were found to have an appropriate dose and duration of systemic corticosteroids.

More than half of the patients (n=96, 50.5 percent) had new or worsening hyperglycaemia, while 13 (6.8 percent) developed hypertension. Thirty- and 90-day readmissions occurred in 46 (24.2 percent) and 78 (41.1 percent) patients, respectively. Of note, readmissions were more common among those without appropriate dose and duration.

“Recent literature and guidelines support treatment of AECOPD with prednisone 40 mg (or equivalent) for 5 days,” the investigators said.